lurking truecel
Kraken
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A important first note is this pic:
This is something you dont want, flaring the teeth out but the bone(blue) stays the same. in this pic(left one) the redline indicates the gained flaring distance. this is not good for the root of the teeth and is also not stable as the tooth is suppose to stay straight, this can happen with MSE with the legs on the appliance if the bone doesnt move. this will increase the width of the arch but is both bad aesthetically and hurts teeths. Also why agga appliance is so bad, as this only moves the teeth(shown in the right pic logically, its only has arms on the teeth).
okay, lets get back to bussiness:
MSE and segmental leforte
lets start with a brief introduction to the two:
lets start with segmental leforte. It is segmental split during a bimax procedure, so when you move the leforte 1 area forward you also split and widen the teeth arch as shown below(it also shows what posterior and anterior part means here):
Either by splitting in three or two pieces, depends on the bite mostly.
A ct scan showing bimax with a three piece segmental split
what is a MSE, it is a appliance you put on top of the roof of your mouth to expand the maxilla, pic below:
A regular MSE appliance
and this is ease appliance, some people really like ease procedure from Kasey li om the US, many like this as he only focus on bone expansion and not teeth flaring(arms).
Now when we understand the two procedures its time to understand the difference between them. lets start with mse as you will se down below:
-What we notices here is that the whole nasal area has expanded, from the floor(green) to the top of the roof of the nose(red). This will ofc have great affect on the nasal breathing as the expansion is horizontally expanded everywhere.
-we can also see that the zygos(purple) and whole midface got wider. we can also see that the right side got a little bit more expanded then the left side, not a big difference, but this is concern with mse that you get asymmetrical expansion.
lets look at the overall positives and negatives from mse:
positives:
- whole nasal region gets expanded which improves the nasal airways
- wider midface
- better smile because less buccal corridors, and wider arch
- widen the teeth anteriorly which leforte 1 segmental doesnt
negatives:
-risk of asymmetrical expansion(especially if you already are assymetric)
-wider nose
-if old you might not get any expansion
-more orthodontics
-if no skeletal expansion in the area painted in the pic above the legs of the mse will just tilt your teeth outward damaging the roots of the teeth
Lets now look at segmental lefort 1 as seen below:
As we can see from the front there is no changes except a wider palate, the nasal walls and roof doesnt get wider, and here is the obvious drawbacks with segmental leforte if you compare it with MSE. The nose volume anteriorly meaning closer to the nostrils doesnt get wider and also not the teeth which can be a drawback, and the roof and walls will not get wider, only the floor. so the nasal volume from MSE will be better as you can figure out and will also show it in pics below(bad painter btw):
Okay, as we can see from this photo the nose volume is like triangle box(green), if we increase with MSE we can increase the whole volume while with segmental we will only make the floor wider which doesnt increase volume as much. So segmental except for making the flor and tiny bit of the walls wider(blue), it will not change nasal volume much. But it will look better when it comes to smile etc still(because wider palate more tooth show, less buccal corridors).
But dont worry because if you are doing a lefort 1 you will already improve nasal breathing a bit, and here is a photo explaining which movements will make nasal breathing better and its all visually easy to see why:
firstly ccw rotation
linear advancement
lastly downgrafting
Conclusion:
when to use mse:
If you have really bad nasal breathing and a really narrow maxilla + want the minimal aesthetic benefit from widening the whole upper maxilla then go with MSE. may increase zygoma width close to the eyes as seen above and also a 1 or 2 mm increase in ipd(i dont know much about this).
When only segmental leforte 1:
You have decent nasal breathing and average teeth arch width. and only want to make the bite better and slightly wider in the leforte 1 area.
Considerations with leforte 1 (ortho treatment before): I mean to even be able to do widening during surgery the lower arch needs to be as wide as lower arch. The lower arch teeths should be pointed straight and not flared inwards(photo below) which many recessedcels teeth do. This is something you need to consider before bimax with an ortho, some orthos might not even understand.
teeth which is flared inwards or caved in as some say aswell.
side note:
Good to know, in the ideal bite the upper arch should be wider then lower arch like this and the teeth should ideally be as straight as possible.
This is something you dont want, flaring the teeth out but the bone(blue) stays the same. in this pic(left one) the redline indicates the gained flaring distance. this is not good for the root of the teeth and is also not stable as the tooth is suppose to stay straight, this can happen with MSE with the legs on the appliance if the bone doesnt move. this will increase the width of the arch but is both bad aesthetically and hurts teeths. Also why agga appliance is so bad, as this only moves the teeth(shown in the right pic logically, its only has arms on the teeth).
okay, lets get back to bussiness:
MSE and segmental leforte
lets start with a brief introduction to the two:
lets start with segmental leforte. It is segmental split during a bimax procedure, so when you move the leforte 1 area forward you also split and widen the teeth arch as shown below(it also shows what posterior and anterior part means here):
Either by splitting in three or two pieces, depends on the bite mostly.
A ct scan showing bimax with a three piece segmental split
what is a MSE, it is a appliance you put on top of the roof of your mouth to expand the maxilla, pic below:
A regular MSE appliance
and this is ease appliance, some people really like ease procedure from Kasey li om the US, many like this as he only focus on bone expansion and not teeth flaring(arms).
Now when we understand the two procedures its time to understand the difference between them. lets start with mse as you will se down below:
-What we notices here is that the whole nasal area has expanded, from the floor(green) to the top of the roof of the nose(red). This will ofc have great affect on the nasal breathing as the expansion is horizontally expanded everywhere.
-we can also see that the zygos(purple) and whole midface got wider. we can also see that the right side got a little bit more expanded then the left side, not a big difference, but this is concern with mse that you get asymmetrical expansion.
lets look at the overall positives and negatives from mse:
positives:
- whole nasal region gets expanded which improves the nasal airways
- wider midface
- better smile because less buccal corridors, and wider arch
- widen the teeth anteriorly which leforte 1 segmental doesnt
negatives:
-risk of asymmetrical expansion(especially if you already are assymetric)
-wider nose
-if old you might not get any expansion
-more orthodontics
-if no skeletal expansion in the area painted in the pic above the legs of the mse will just tilt your teeth outward damaging the roots of the teeth
Lets now look at segmental lefort 1 as seen below:
As we can see from the front there is no changes except a wider palate, the nasal walls and roof doesnt get wider, and here is the obvious drawbacks with segmental leforte if you compare it with MSE. The nose volume anteriorly meaning closer to the nostrils doesnt get wider and also not the teeth which can be a drawback, and the roof and walls will not get wider, only the floor. so the nasal volume from MSE will be better as you can figure out and will also show it in pics below(bad painter btw):
Okay, as we can see from this photo the nose volume is like triangle box(green), if we increase with MSE we can increase the whole volume while with segmental we will only make the floor wider which doesnt increase volume as much. So segmental except for making the flor and tiny bit of the walls wider(blue), it will not change nasal volume much. But it will look better when it comes to smile etc still(because wider palate more tooth show, less buccal corridors).
But dont worry because if you are doing a lefort 1 you will already improve nasal breathing a bit, and here is a photo explaining which movements will make nasal breathing better and its all visually easy to see why:
firstly ccw rotation
linear advancement
lastly downgrafting
Conclusion:
when to use mse:
If you have really bad nasal breathing and a really narrow maxilla + want the minimal aesthetic benefit from widening the whole upper maxilla then go with MSE. may increase zygoma width close to the eyes as seen above and also a 1 or 2 mm increase in ipd(i dont know much about this).
When only segmental leforte 1:
You have decent nasal breathing and average teeth arch width. and only want to make the bite better and slightly wider in the leforte 1 area.
Considerations with leforte 1 (ortho treatment before): I mean to even be able to do widening during surgery the lower arch needs to be as wide as lower arch. The lower arch teeths should be pointed straight and not flared inwards(photo below) which many recessedcels teeth do. This is something you need to consider before bimax with an ortho, some orthos might not even understand.
teeth which is flared inwards or caved in as some say aswell.
side note:
Good to know, in the ideal bite the upper arch should be wider then lower arch like this and the teeth should ideally be as straight as possible.
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